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Chapter 43 - Liver transplantation in children: indications and surgical aspects
- from Section V - Other considerations and issues in pediatric hepatology
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- By M. Kyle Jensen, University of Utah, Primary Children’s Medical Center, Salt Lake City, UT, USA, Maria H. Alonso, Department of Pediatrics, Northwestern University, Chicago, and Director of Hepatology, Department of Gastroenterology, Hepatology and Nutrition, Children’s Memorial Hospital, Chicago, IL, USA, Jaimie D. Nathan, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA, Frederick C. Ryckman, Pediatric Surgery Training Program, Pediatric Liver Care Center, Cincinnati Children’s Hospital, Cincinnati, OH, USA, Gregory M. Tiao, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, William F. Balistreri, University of Cincinnati College of Medicine
- Edited by Frederick J. Suchy, University of Colorado Medical Center, Ronald J. Sokol, University of Colorado Medical Center, William F. Balistreri
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- Book:
- Liver Disease in Children
- Published online:
- 05 March 2014
- Print publication:
- 20 February 2014, pp 760-772
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Summary
Introduction
Liver transplantation has become the standard of care for end-stage liver disease in children and successful outcomes are now achieved in the vast majority of transplant recipients. Progressive improvement has occurred through better preoperative care of patients with liver disease, improved operative techniques that has allowed the donor pool to expand, and improved immunosuppression strategies to prevent rejection while avoiding complications of over-immunosuppression. The success of the past, however, has also bred unique challenges for the future. With the increasing number of liver transplant candidates, improved donor awareness and organ availability must occur. A delicate balance between the risks assumed by living donors and the needs of their children must be struck. The increasing numbers of surviving patients present unique challenges and complications related to lifelong immunosuppression. The future success of pediatric liver transplantation will require appreciation of the increasingly complex care needs of this population and a national focus on donor organ shortages.
The evaluation process
Collective experience suggests that the progression of chronic liver disease is not linear, but rather exponential, suggesting that early warning signs of hepatic compromise, such as deteriorating synthetic function or refractory nutritional failure should lead to prompt evaluation. In children with acute liver failure (ALF) or rapidly progressive decompensation of chronic disease, aggressive critical care intervention is essential to maintain all other physiologic systems until a suitable donor organ becomes available.
8 - Thyroid and parathyroid (including thyroglossal disorders)
- from Part II - Head and neck
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- By Jaimie D. Nathan, Duke University Medical Center, Durham, NC, USA, Michael A. Skinner, Duke University Medical Center, Durham, NC, USA
- Edited by Mark D. Stringer, Keith T. Oldham, Pierre D. E. Mouriquand
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- Book:
- Pediatric Surgery and Urology
- Published online:
- 08 January 2010
- Print publication:
- 09 November 2006, pp 90-103
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Summary
Since the first thyroidectomy was reportedly performed by the Moorish surgeon Albucasis in AD 330, the surgical treatment of thyroid and parathyroid disorders has been approached with trepidation. Even with modern technical advances, many regard pathology in this anatomic location only operable by those with significant experience. This notion is especially true in children. The technical difficulties are more pronounced in younger individuals, and these children must survive a lifetime with the end result of their surgeon's work.
In this chapter, the long-term outcome of surgical diseases of the thyroid and parathyroid glands, including thyroglossal disorders, in children is discussed. Graves' disease, the most common of these disorders, is the first entity considered. Malignancies of the thyroid gland are then considered with a discussion of papillary and follicular carcinoma, followed by a review of medullary carcinoma of the thyroid. Next, childhood disorders of the parathyroid glands are discussed, with emphasis on hyperparathyroidism. Finally, we consider the management and long term outcome of thyroglossal disorders, including cysts and sinuses.
Graves' disease
Toxic diffuse goiter or Graves' disease is the most common cause of hyperthyroidism in children. It is more common in girls than boys, with a ratio of approximately 4:1 to 5:1, and the incidence increases throughout childhood with a peak in the adolescent years.
Graves' disease is an autoimmune process mediated by circulating autoantibodies to the thyroid stimulating hormone (TSH) receptor present on the follicular cells of the thyroid gland.